Predictive value of preoperative serum albumin levels on outcomes in patients undergoing LVAD implantation

Critsinelis, Andre C.; Kurihara, Chitaru; Kawabori, Masashi; Sugiura, T.; Lee, Vei Vei; Civitello, Andrew B.; Morgan, Jeffrey A.

doi:10.1111/jocs.13745

Cited by 27 publications

(17 citation statements)

References 22 publications

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“…However, no correlation between low BMI (< 20 kg•m − 2 ) and low SAL (< 25 g•L − 1 ) has been reported [4]. Furthermore, SAL has been considered as an independent prognosis marker in several studies related with CS procedures, even in the setting of newer technology, such as transcatheter aortic valve replacement and left-ventricular assist device [5][6][7]. The level of hypoalbuminemia required to increase the risk of these outcomes has not been properly defined and varies depending on the study (i.e., under 20, 35 or 40 g•L − 1 ) [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

The influence of postoperative albumin levels on the outcome of cardiac surgery

Berbel-Franco

López-Delgado

Putzu

et al. 2020

J Cardiothorac Surg

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Background: The prognostic role of low postoperative serum albumin levels (SAL) after cardiac surgery (CS) remains unclear in patients with normal preoperative SAL. Our aim was to evaluate the influence of SAL on the outcome of CS. Methods: Prospective observational study. Patients undergoing CS with normal preoperative SAL and nutritional status were included and classified into different subgroups based on SAL at 24 h after CS. We assessed outcomes (i.e., in-hospital mortality, postoperative complications and long-term survival) and results were analyzed among the different subgroups of SAL. Results: We included 2818 patients. Mean age was 64.5 ± 11.6 years and body mass index 28.0 ± 4.3Kg•m − 2. 5.8%(n = 162) of the patients had normal SAL levels(≥35 g•L − 1), 32.8%(n = 924) low deficit (30-34.9 g•L − 1), 44.3%(n = 1249) moderate deficit (25-29.9 g•L − 1), and 17.1%(n = 483) severe deficit(< 25 g•L − 1). Higher SAL after CS was associated with reduced in-hospital (OR:0.84;95% CI:0.80-0.84; P = 0.007) and long-term mortality (HR: 0.85;95% CI:0.82-0.87;P < 0.001). Subgroups of patients with lower SAL showed worst long-term survival (5-year mortality:94.3% normal subgroup, 87.4% low, 83.1% moderate and 72.4% severe;P < 0.001). Multivariable analysis showed higher in-hospital mortality, sepsis, hemorrhage related complications, and ICU stay in subgroups of patients with lower SAL. Predictors of moderate and severe hypoalbuminemia were preoperative chronic kidney disease, previous CS, and longer cardiopulmonary bypass time. Conclusions: The presence of postoperative hypoalbuminemia after CS is frequent and the degree of hypoalbuminemia may be associated with worst outcomes, even in the long-term scenario.

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Section: Introductionmentioning

confidence: 99%

The influence of postoperative albumin levels on the outcome of cardiac surgery

Berbel-Franco

López-Delgado

Putzu

et al. 2020

J Cardiothorac Surg

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“…In one study of nearly 500 patients who underwent LVAD implantation, low serum albumin levels preoperatively were associated with lower survival, increased risk for postoperative infection, gastrointestinal bleeding, neurologic dysfunction, and acute kidney injury …”

Section: What Factors Should One Consider In Selecting Older Candidatmentioning

confidence: 99%

Left Ventricular Assist Device Therapy in Older Adults: Addressing Common Clinical Questions

DeFilippis

Nakagawa

Maurer

et al. 2019

J American Geriatrics Society

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OBJECTIVES To review the literature and summarize the evidence for left ventricular assist device (LVAD) use in older adults (aged >75 years), highlighting patient selection, day‐to‐day life with an LVAD, age‐specific complications, and end‐of‐life considerations. DESIGN Contemporary review of current literature on LVAD therapy in older adults. RESULTS There is a paucity of data on LVAD use and outcomes in adults older than 75 years and even less commonly are such devices implanted in those older than 80 years. Candidates and recipients of this age often have multiple chronic conditions and extracardiac impairments, which can negatively affect their short‐term outcomes and daily experience following LVAD implantation. Therefore, selection prior to implant should incorporate end‐organ function, nutritional status, measures of frailty, neurocognitive status, and social support, among others, to determine the patient population most likely to benefit from such therapy. CONCLUSION When LVAD therapy is utilized in an older adult, the needs for multidisciplinary team management and expertise in palliative care are essential. More age‐specific outcome data are required to help inform providers, patients, and caregivers. J Am Geriatr Soc 67:2410–2419, 2019

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“…For instance, some reports have demonstrated prealbumin to be predictive of postimplant adverse events, specifically infection and wound healing complications, whereas others have demonstrated reductions in longer‐term survival 2,5,6 . To further complicate the interpretation of these studies, some of the available studies pursued diverse surrogate measures of preoperative nutritional status while also spanning multiple treatment eras 7,8 . As the rates of postimplant adverse events in the modern era have become significantly reduced through more standardized preoperative screening, optimization, and postoperative management, the question of if a nutritional measure alone can predict adverse events remains uncertain 9 .…”

Section: Introductionmentioning

confidence: 99%

Preoperative prealbumin does not impact outcomes after left ventricular assist device implantation

et al. 2020

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Background: This single-center, the retrospective study evaluates the impact of preoperative serum prealbumin levels on outcomes after left ventricular assist device (LVAD) implantation.Methods: Adults undergoing LVAD implantation, with a recorded preoperative prealbumin level, between 2004 to 2018 were included. Primary outcomes included rates of 1-year survival and secondary outcomes included rates of postimplant adverse events. Threshold regression and restricted cubic splines were utilized to identify a cut-point to dichotomize prealbumin level. Prealbumin was also evaluated as a continuous variable. Multivariable logistic regression was used for risk-adjustment.Results: A total of 333 patients were included. Patients were dichotomized according to an optimal prealbumin threshold of 15 mg/dL: 47.4% (n = 158) had levels below and 52.6% (n = 175) had levels above this threshold, respectively. The rates of postimplant adverse events, including bleeding, infection, stroke, renal failure, and right heart failure, were similar between the groups (all P > .05). Furthermore, the rates of cardiac transplantation and device explantation were also similar (all P > .05). Unadjusted survival was comparable between the groups at 30-days, 90-days, and 1-year following LVAD implantation (all P > .05). In addition, lower prealbumin did not impact risk-adjusted 1-year mortality when modeled either as a categorical (OR, 1.08; 95% CI, 0.48-2.12; P = .82) or continuous variable (OR, 1.99; 95% CI, 0.73-2.34; P = .96). Conclusions:This study demonstrates that lower prealbumin levels were not predictive of increased post-LVAD morbidity or mortality. Although an established marker of nutritional and inflammatory status, the role of prealbumin in patient selection or prognostication appears limited in LVAD patients. K E Y W O R D S adverse events, left ventricular assist device, prealbumin, survival Yeahwa Hong and Laura Seese are co-first authors.

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Predictive value of preoperative serum albumin levels on outcomes in patients undergoing LVAD implantation

Cited by 27 publications

References 22 publications

The influence of postoperative albumin levels on the outcome of cardiac surgery

The influence of postoperative albumin levels on the outcome of cardiac surgery

Left Ventricular Assist Device Therapy in Older Adults: Addressing Common Clinical Questions

Preoperative prealbumin does not impact outcomes after left ventricular assist device implantation

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